EQUIP: A programme designed to test the boundaries of health care provision.

23 May 2018, Tim Burton -

There is a new TUF-sponsored research programme that has the potential to change the face of health care in England.

EQUIP (Education in Quality Improvement Programme) is looking at how urology health care professionals can learn more and more from the incidents they encounter and to instil this culture of learning within the NHS so that patient care will always be improving. The programme aims to be applicable across all healthcare disciplines and is starting to make in-roads.

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EQUIP is a research programme that aims to bring the principle of Quality Improvement (QI) to urology training with a view to building long-term capability for improvement within the NHS to optimise patient outcomes. It is an exciting opportunity to push the urology field to the forefront of a new area in medical care.

QI is a systematic approach to improving patient care ; its principles originate from engineering, where a problem or failing in a project would be systemically reviewed, recorded, and learnt from. If something went wrong in a project, engineers would ask their five whys until they could be in a position to prevent a reoccurrence of the same problem and project performance could be optimised.

The principles behind QI need strengthening within the NHS today, but the EQUIP project is hoping to change that, starting with urology.

The programme is looking at how urology trainees can be taught QI as a part of their curriculum so that they can implement these principles into their work as urologists. In the future this could mean that any serious incidents, problems in clinical pathways or near misses could be reviewed and improved using QI methodologies. These improvements could then be recorded in a way that makes them accessible to urologists outside of the specific Trust where the incident took place.

Crucially, QI means that new strategies will be developed so that incidents can be avoided and care processes improved in the future. It will mean unprecedented opportunities to learn and to improve patient care across the field.

What could this mean for urology in the UK?

It could be deeply transformative for the speciality. If successful, the project will allow unprecedented opportunities to optimise patient care. The hope is that urology will become a flag bearer for QI within the NHS and that other specialities will be able to learn from the experience of urologists.

As well as this, the team aspires to change how healthcare professionals interact; opportunities to learn from colleagues across the country will be a regular part of QI as experiences and new effective improvement strategies will be widely shared for the benefit of other professionals. Ultimately, QI will mean no more time, money, and resources wasted on repeated errors or improvement projects that cannot be successfully scaled up. It will mean a better and safer urology service in this country.

Who is running the EQUIP project?

The EQUIP project is supported by TUF, and is being implemented by a team at King’s College London and Barts that is headed up by Professor Nick Sevdalis, a professor of implementation science and patient safety, and Professor James Green, a consultant urologist and Urology Network lead at Barts Health NHS Trust.

Elena Pallari, a QI expert from a bio-chemical engineering background, is the researcher for the project, further supported by Dr Zarnie Khadjesari a Senior Lecturer in Health Promotion and senior improvement scientist of the University of East Anglia. The programme is further supported by a steering board that is comprised of urologists, nurses, trainees, patients and medical education experts.

What has happened so far?

As the project researcher, Elena has begun the process of reviewing existing research into applying QI to a medical context. She has interviewed urology consultants and trainers, and has run focus groups with trainees. What she has found is that all of these groups are overwhelmingly positive about QI, they would like formal training on QI methods, and that trainees want more clarity on the curriculum.

Through this, the team have been able to develop a pilot training module that has been tested with two groups of urology trainees in national Bootcamps. They are now looking at how this pilot can improved and rolled out further into the trainee curriculum, without putting undue pressure on the already taxing trainee curriculum.

What’s next?

BAUS 2018 annual conference is next. The team will be hosting a podium discussion as well as a training workshop for consultants at BAUS 2018 so that they can get feedback and opinions from urologists and also continue to develop QI expertise within the specialty.

At the same time, Elena is continuing a systematic review of the relevant studies into QI in Surgery so that, when this is implemented further into urology training, it will benefit from past experiences and have the best possible chance of succeeding.

What can you, as urologists, do?

QI has been tested in medical care a number of times before across the world, but the problem remains that scaling up successful improvement projects has only ever been sporadic. The EQUIP team have every intention of making this a lasting programme that will see a scalable transformation of urology over the coming decades.

With your buy-in, insight, and continued support, EQUIP will be able to deliver on its ambition.

If you, your trainees, or colleagues have the opportunity to contribute to this process, please do, perhaps starting with the podium discussion and training workshop at the upcoming BAUS 2018 conference. As well as this, please share the news of this project, and look out for updates from TUF.